The adult cancer survivor: psychosocial consequences of cure

This article has summarized the psychosocial sequelae identified for the adult cancer survivor. The themes that have been identified relate to loss, compromise, and uncertainty. There is, as yet, no evidence of increased psychopathology in this population. Research on this subject is sparse and difficult to interpret. Consistent definitions of survival across studies is needed in order to compare findings. Although no specific length of time is precise for a given individual, information does exist that would assist in defining long-term survival for a given disease. The use of sensitive measures and appropriate comparison groups is an important consideration in future studies. Instruments that measure psychopathology have often been used; however, these instruments appear not to be sensitive to the more subtle levels of psychological distress and problems associated with long-term survival. Schipper and Levitt have emphasized the need for more discriminating tools. Spitzer and colleagues propose the use of in-depth psychological interviews as optimal in this regard. Comparison groups have varied from neighbors, friends, college students, psychiatric patients, and national surveys. In addition to a lack of consistency among these groups, questions have been raised in the literature as to what degree these groups represent the general population. Schipper and Levitt suggest that patients might best be used as their own controls and followed over time. Through increased understanding, strategies for prevention and intervention can be designed. An editorial in the newsletter for the National Coalition for Cancer Survivorship states, "the strength of the survivorship movement can be measured, in part, by the fact that these activities have developed independently, without coordination.(ABSTRACT TRUNCATED AT 250 WORDS)     

Psychosocial consequences of childhood cancer

This article summarizes findings regarding the psychosocial late effects of chronic childhood cancer on long-term survivors. Overall, the psychosocial adjustment of many survivors appears to be within the normally expected range. Studies that compared cancer survivors with healthy controls on standardized scales found few or no significant differences in psychopathology. However, more subtle concerns or problems related to physical impairments, vocational discrimination, economic burden, and early and open communication within the family were identified. More research is needed to fully understand these subtle difficulties and to identify intervention strategies to prevent psychosocial late effects from occurring, and to ameliorate them when they are present.     

Breast cancer: psychosocial consequences for the patient

Women with breast cancer experience various psychosocial problems throughout the continuum of the disease. The psychosocial impact and adjustment of women with breast cancer during the phases of pretreatment, primary treatment, adjuvant therapy, recurrence, and advanced disease have numerous implications for nursing practice and research.     

Self-reported psychosocial wellbeing of adolescent childhood cancer survivors

PurposeTo describe self-reported psychosocial wellbeing of adolescent childhood cancer survivors (CCS) compared with a control group of their peers.MethodsIn this case–control study, 170 CCS aged 12–18 years completed an internet survey. The survey was a modified version of the Youth’07 Health and Wellbeing Survey of Secondary School Students in New Zealand. The control group (historical comparison) were the 9107 Youth’07 survey participants. Psychosocial wellbeing was assessed by measures of a) wellbeing (WHO-5), b) anxiety (MASC-10), c) depression (RADS2-SF) and d) emotional and behavioural difficulties (SDQ).ResultsThe majority of CCS scored within the normal range across all four measures: wellbeing (89%), anxiety (93%), depression (94%) and emotional and behavioural difficulties (82%), leaving a small but important minority of CCS reporting significant clinical issues. Compared to their peers, adolescent CCS were no more likely to have an abnormal score for any of the psychosocial measures, and less likely to report abnormal psychosocial wellbeing (OR = 0.44, p = 0.0003) and prosocial behaviour problems (OR = 0.53, p = 0.009). Survivors of central nervous system tumours, older age, older age at diagnosis, and lower socioeconomic status were associated with some psychosocial difficulty.ConclusionsFollowing a diagnosis of childhood cancer, intensive therapy, and the subsequent risk of adverse health outcomes, one might expect CCS to be doing less well than their peers in terms of psychosocial wellbeing. The findings of this study, however, show that CCS are doing as well, and in some respects better, than their peers.     

The role of cognitive remediation in childhood cancer survivors experiencing neurocognitive late effects.

With the increasing number of children becoming long-term cancer survivors, it has become evident that these survivors are experiencing long-term neurocognitive deficits. Many of these deficits have been found to be the result of cancer-related therapies including intravenous and intrathecal chemotherapy and cranial radiation. These neurocognitive deficits include learning disabilities, cognitive deficits, attention disorders, and difficulties with memory. Cognitive remediation therapy uses a systematic approach to learning strategies that is aimed to equip these affected children with proper, effective, and proven learning strategies. This article will briefly discuss the neurocognitive deficits experienced by long-term childhood cancer survivors. Cognitive remediation therapy will then be introduced with specific attention to the cognitive remediation program developed by Butler and Copeland. Finally, implications for practice and future research will be discussed.     

The psychosocial aspects of breast cancer

Few issues prepare women to cope with the multitude of problems that confront them when diagnosed with breast cancer. The provision of appropriate treatment requires that health care professionals attend to the emotional, social, and other nonmedical functioning of the woman and her family. Nurse practitioners play a central role in the delivery of medical care. This article describes the typical response of women to breast cancer and factors associated with risk for the development of comorbid psychological and adjustment problems. Pragmatic suggestions to guide nurse practitioners in assisting patients and their families cope with breast cancer are provided, as well as indicators for referral to a mental health professional.     

Young adult survivors of childhood cancer: Attending to emerging medical and psychosocial needs

As survival rates for childhood cancer have increased during the past three decades, a significant population of young adult survivors has emerged. Medical late effects of particular concern to this population, including reproductive issues, osteoporosis, cardiotoxicity, hepatitis C, and second malignancies are discussed. Educational, occupational, insurance, and other significant psychosocial sequelae are addressed. Models for medical and psychosocial follow-up with this population are described, and a psycho-educational intervention model, implemented by members of the Long-term Information, Follow-up, and Evaluation (LIFE) team at Childrens Hospital Los Angeles, is presented for consideration. Future research and clinical challenges are discussed.     

Positive and negative consequences of childhood cancer influencing the lives of young adults

The aim of the study was to describe how young adults who have survived childhood cancer consider their present life to be influenced by the cancer experience. A cohort of 246 long-term survivors were approached a median of 16 years after diagnosis. Semi-structured telephone interviews were conducted based on the Swedish version of the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW). Interviews were analysed using content analyses. When asked if cancer negatively or positively currently affected their lives, 68% reported at least one negative consequence and 53% at least one positive consequence. The most frequently reported negative consequences include a variety of physical impairments and limitations in participating in activities; positive consequences describe a more positive view of life and of self. Women more often than men reported negative psychological impact, a changed body appearance and positive interaction with others. CNS tumours and combined treatment were somewhat associated to a higher extent of negative consequences. Overall, the results indicate that long-term survivors of childhood cancer are getting along quite well despite shortcomings.     

Difference in patient's acceptance of early versus late initiation of psychosocial support in breast cancer

The present study was performed to assess the difference in acceptance of psychosocial counseling and resulting benefits between patients with breast cancer with early or late onset. In a prospective randomized controlled study conducted over 6 months, 41 women with a new diagnosis of early breast cancer (group 1) and 43 patients with advanced breast cancer (group 2) received individually tailored psychosocial support and were compared against controls. This therapy was free of charge, and the duration of support was determined by the patients' wishes and needs. Among the patients with new onset of disease acceptance of the psychosocial counseling was high, and these patients experienced significant improvements in their quality of life. In contrast, acceptance of psychosocial counseling was low in the advanced breast cancer group and the therapy did not improve quality of life over the observation period of 6 months. Early psychosocial support in patients with breast cancer meets with a high acceptance rate and improves quality of life.     

Posttraumatic stress disorder: Understanding the psychosocial impact of surviving childhood cancer into young adulthood

Little research has been done to explore how the psychological symptoms of child and adolescent cancer survivors change in the decades following successful treatment. This article examines these changes with a focus on the utility of a posttraumatic stress framework for understanding the long-term coping issues that individuals face as they mature and make transitions to young adulthood. First, the literature supporting the use of a posttraumatic stress framework in child and adolescent survivors is reviewed. Developmental contributions to changes and increases in posttraumatic symptomatology during young adulthood are then discussed and posttraumatic symptoms most often seen in this group are presented. Preliminary research with young adult survivors is also reviewed and discussed as support for a posttraumatic stress framework with this population. Ongoing research efforts aimed at elaborating on this framework are described. Finally, clinical implications for health care providers are explored, and guidelines for assessing the impact of posttraumatic stress on young adults' use of health care resources are offered.     

The role of the long-term follow-up clinic in discovering new emerging late effects in adult survivors of childhood cancer

Our understanding of late effects in long-term survivors of childhood cancer is continually evolving as significant numbers of survivors are entering middle to later adulthood. Effects of conventional treatment on premature aging are being recognized, as are long-term effects of newer therapies. Clinicians in long-term follow-up clinics are in a unique position to monitor for recognized late effects and to be alert to signs and symptoms of late effects that have not been previously reported in the pediatric cancer literature. This article presents 2 young adult survivors who displayed subtle signs of impaired cerebral blood flow due to carotid artery stenosis many years after being treated with neck irradiation. When the first patient presented nearly a decade ago in the clinic with symptoms, premature carotid artery disease was not a radiation-related late effect that had been reported previously in survivors of childhood cancer. These cases are used to illustrate the key role of long-term follow-up clinics in identifying new and emerging treatment-related late effects and underscore the importance of lifetime surveillance and the need for collaboration between pediatric and adult health care providers.     

Long-term consequences of childhood physical and sexual abuse

Psychiatric nurses are confronted daily with individuals who are suffering from the consequences of trauma. Physical and sexual abuse is associated with acute psychiatric symptomatology in children and may progress to a spectrum of psychiatric and medical disorders in adults, ranging from the extreme adaptive reactions seen in multiple personality disorder and refractory psychosis to intermediate adaptive reactions present in borderline personality disorder to more delimited reactions manifest in chronic headaches and unremitting pelvic pain. Subjects sampled in inpatient, outpatient, psychiatric, medical, criminal, and community settings describe the link between histories of widespread abuse and various intractable and common disorders. This article presents the state-of-the-are knowledge of the long-term sequelae of childhood physical and sexual abuse by critically reviewing the initial uncontrolled investigations and mounting evidence from controlled studies.     

Early childhood consequences of polydrug use during pregnancy

ObjectivesPolydrug use in pregnancy exposes children to perinatal consequences, but also to long lasting effects resulting both from their mothers' abuses and lifestyles or socioeconomic deprivation.Study designThe 167 children born alive from 1999 to 2008 whose mothers used at least two substances at the beginning of their pregnancies were either followed up medically or their locations were traced at the end of 2010. One had died from sudden infant death syndrome. 20 could not be found, their mothers having moved.ResultsThe intrauterine growth restriction varied considerably according to the number of abused products, and even more so when the mothers used four products or more including alcohol. Prematurity concerned 22.4% of the children but 31.3% when the mothers used four substances or more. If 25 children were separated from their mothers at discharge, at the end of the follow-up 41 had been separated, out of whom 12 were adopted and the others fostered. Six mothers died during this period.Birth defects were assessed, mainly 8 FAS, 1 microcephaly and 1 down's syndrome. One girl was shaken to blindness. 22.8% of the children were described as having behavioral problems and 13.8% learning difficulties but only 4% benefited from special need education.ConclusionsCompared to the results published in the last two decades, the data from this cohort show a clear decrease in severe birth adverse events, and maternal deaths. The long term prognoses seem influenced mainly by the number of products used during pregnancy, especially alcohol, the mothers' lifestyles and social deprivation.